CASE STUDY
newcenturyhealth.com
A Delegated-Risk Model for Driving Down
Cardiovascular Care Costs and Improving Quality
New Century Health leverages a specialist network to reduce inappropriate
procedures and achieve savings for a Medicare Advantage plan.
© 2019 New Century Health • NCH-1911749-0603
THE SOLUTION
New Century Health (NCH) agreed to:
• Accept fully delegated clinical and financial risk for the
plan's cardiac patients under a capitated arrangement.
• Contract cardiologists through an aligned value-based
payment model to provide care at 11 primary care
clinics owned by the plan.
• Deliver comprehensive services at the clinics and affiliated
hospitals, including clinical cardiology, onsite diagnostic testing,
cardiovascular interventions, electrophysiology and surgery.
• Prospectively approve, through a clinical decision support
platform, procedures performed by cardiologists and provide
evidence-based guidance to the primary care physicians
ordering cardiac screening diagnostics and services.
WHY OUR APPROACH WORKS
• Clinical review, including Medicare coverage determinations
and American College of Cardiology Appropriate Use
Criteria, reduces overutilization and leads to treatments
with the highest patient benefit-to-risk ratios.
• Value-based payment models correct provider-payer
misalignments common in fee-for-service.
• NCH builds high-performing specialty physician networks—
in this case by embedding its contracted cardiologists
within the plan-owned primary care clinics.
In the first year of this
partnership the plan realized
more that $5 million in
savings and experienced:
THE RESULTS
$7.81
Part A
Savings Across
80 Diagnostic
Related
Groupings
PMPM
23%
Reduction
in Part B
Utilization
Run Rate
$6.77
Part B
Savings
PMPM
THE CHALLENGE
The client needed to deliver coordinated, high-quality cardiovascular care to 32,000 Medicare Advantage
members assigned to its wholly owned, multispecialty provider network. However, managing cardiac care
costs had become increasingly difficult in the client's fee-for-service provider reimbursement environment.
Lacking a comprehensive clinical review process, physicians frequently ordered cardiac procedures that
were inappropriate, exposing patients to additional risks and increasing the cost of care.